RT Journal
A1 Elmore JR, Clark DE, Isler RJ, Homer WR
T1 SElective nonoperative management of blunt splenic trauma in adults
JF Archives of Surgery
JO Archives of Surgery
YR 1989
FD May 1
VO 124
IS 5
SP 581
OP 586
DO 10.1001/archsurg.1989.01410050071015
UL http://dx.doi.org/10.1001/archsurg.1989.01410050071015
AB • The use of selective nonoperative management of blunt splenic trauma in adults is based on the undeniable benefits of this approach in children. Proper patient selection requires hemodynamic stability, lack of generalized peritoneal irritation, and minimal blood transfusion needs. Computed tomography is now used to make the diagnosis, but the decision for laparotomy is based on clinical grounds. Forty-one (87%) of 47 patients selected for nonoperative management were treated successfully without laparotomy, while the remaining 6 patients underwent delayed operations for persistent splenic bleeding. Blood transfusion requirements were significantly less in the observed group than in the operative group for patients with isolated trauma and for patients with polytrauma. There were no known missed intra-abdominal injuries and no deaths with the nonoperative approach. Analysis of our results has confirmed that nonoperative management is a safe and effective alternative to immediate laparotomy in properly selected patients and it can result in splenic salvage without the need for an operation.(Arch Surg. 1989;124:581-586)